The “tell-all” lawsuit alleges acts of favoritism and corruption at Brownsville ISD. Among the allegations are favoritism with school district contracts and retaliation against those who asked questions. BISD school board members Luci Longoria and Caty Presas are suing the school district they were elected to represent. The two are also suing Superintendent Carl Montoya, school district attorney Baltazar Salazar and their fellow board members.

SUMMARY:Online health-cost pricing tools pop up every day, a reflection of the changing marketplace, and the way transparency in costs is rolling over the industry like an irresistible force. Some are better than others. We were interested, then, to see this amazing Texas pricing tool.

“Due to recent reforms to the individual health insurance market, it no longer makes financial, logical or social sense for employers to continue offering group health insurance plans to employees.”

Editor’s Note: The following article is provocative. Individual plans are not underwritten and are guarantee issue. Group plans for groups of 50 or more are underwritten and not guarantee issue. PPACA has caused a 180 degree shift in paradigm.

“There’s a new mindset for employers, and it’s beginning to be understood by employees. This is being driven by a combination of the ACA spurring a move toward defined contribution models and private exchanges, and a focus on member engagement and increased responsibility. For the employer and employees, these are major shifts.” –Reference Based Pricing, Individual Responsibility & Willing Providers

Remember when Medicare was passed with little Republican support? Remember the outrage?:

Ronald Reagan: “[I]f you don’t [stop Medicare] and I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” [1961]

George H.W. Bush: Described Medicare in 1964 as “socialized medicine.” [1964]

Barry Goldwater: “Having given our pensioners their medical care in kind, why not food baskets, why not public housing accommodations, why not vacation resorts, why not a ration of cigarettes for those who smoke and of beer for those who drink.” [1964]

Bob Dole: In 1996, while running for the Presidency, Dole openly bragged that he was one of 12 House members who voted against creating Medicare in 1965. “I was there, fighting the fight, voting against Medicare . . . because we knew it wouldn’t work in 1965.” [1965]

Barry was on the mark, except we are still waiting for our free government paid vacation resorts, cigarettes and beer!

These days you cannot find one single Republican against Medicare. History seems to be repeating itself with ObamaCare…………………….

U.S. Chief District Judge Fred Biery sentenced three individuals to federal prison for their role in a money laundering and tax fraud scheme.

U.S. Chief District Judge Fred Biery handed down prison sentences to three individuals in their role in a $133 million loss fraud and tax-related case. This is the largest case of its kind ever prosecuted in the Western District of Texas.

John Bean, the owner of San Antonio-based Synergy Personnel, was sentenced to six years in federal prison, followed by three years of supervised release. The judge ordered Bean to pay more than $120 million in restitution after pleading guilty to a money laundering charge and mail fraud conspiracy charge in March 2013.

Pat Mire, the owner and manager of several San Antonio-based professional employer organizations, was sentenced to three years in federal prison, followed by three years of supervised release. Mire was ordered to pay $10 million in restitution after pleading guilty to a money laundering charge and a mail fraud conspiracy charge in November 2011.

Mike Solis, an executive assistant at several San Antonio-based PEOs, was sentenced to two years in federal prison followed by three years of supervised release. He pleaded guilty a mail fraud conspiracy charge in December 2012.

A fourth defendant, John D. Walker II, also an owher and manager of several San Antonio-based PEOs, was sentenced to five years probation and ordered to pay $450,000 after pleading guilty to a Klein tax fraud conspiracy charge and for making false statements in May 2012.

United States Attorney Robert Pitman, Acting FBI Special Agent in Charge Aaron C. Rouse and IRS-Criminal Investigation Special Agent in Charge Steve McCollough made the announcement. Prosecutors claim that the business owners siphoned off money from payroll clients and failed to pay taxes.

“Motivated by greed, the defendant perpetrated an extensive fraud scheme, designed to steal money from their clients and taxpayers over a number of years. The FBI will continue to work with our partners to identify, investigate and prosecute others, like the defendant, who seek unjust enrichment by victimizing others,” Rouse in a release.

“The defendants involved in this, the largest ever single criminal tax case in San Antonio’s history, knowingly violated our country’s tax laws. They chose to ignore their responsibilities and live a lavish lifestyle on money belonging to their employees and to the U.S. Government. IRS Special Agents will continue to aggressively pursue these types of very serious tax crimes,” IRS-Criminal Investigation Special Agent in Charge Steve McCollough said in a release.

Here’s my latest Huffpost blog. It was just published today; two full weeks after I submitted it. I’m not sure why they took so long to publish this blog but, it might have been because they thought the accusations I made were a bit more controversial than usual (even for me) so they wanted to take a little extra time to check my sources. Basically it’s about how a pharmaceutical company can subvert medical research to make a new and very expensive medication appear to a better choice than an inexpensive alternative when it probably isn’t any better. The provides a good example of why every doctor should be very skeptical of any research that’s funded by a pharmaceutical company.

Last week, I started on what I figured might be a tedious but straightforward task: calling local hospitals to get a price for the thyroid biopsy my doctor ordered. My insurance coverage is skimpy, so I wanted to shop around. But, holy phone tree—wrangling prices from our city’s hospitals turned out to be no ordinary errand. It was a journey, an adventure, a safari! I’m still dreaming about CPT codes.

NEW YORK (Reuters) – The U.S. government is expected to announce this week the proposed payment rates for insurer-run Medicare plans in 2015, but industry officials say the anticipated cuts will mean higher co-pays and fewer benefits for seniors.

Humana is working with retail giant Walmart to provide expanded access to health care in San Antonio. The Louisville, Ky.-based company has developed three new Humana Health & Well-being Centers that will be open to its members and to the general public. Two of those centers will officially open later this month in Alamo City Walmart stores located at S.E. Military Drive and 6703 Leslie Road.

The idea is that, instead of paying for or subsidizing employees’ insurance costs and reflecting that in the menu prices, the cost is unbundled and there for all to see.
I like this form of transparency.

On the other hand, some folks are concerned that they have “no way of knowing whether the restaurant will use the extra money for the stated cause.”
Which is a valid objection.

“Humana announced that it expects to tap the three risk adjustment mechanisms in ObamaCare for between $250 and $450 million in 2014. This amounts to about 25 percent of the insurer’s expected exchange revenue.”

“Charge Employees the Maximum Allowable Premium. This I think will be the most attractive strategy. Under the ACA, health insurance is deemed “affordable” if the employee’s premium does not exceed 9.5% of the employee’s wages.” See (Employees Pay For ObamaCare As Condition of Employment?).

After delaying the employer mandate to provide ObamaCare health insurance to all full time employees for a year, the administration has delayed the mandate for medium size business for a second year. It has also relaxed the mandate for large businesses (they only have to cover 70% of their workers the next year).

All of this is lawlessness of course. The statute clearly says that the mandate is supposed to kick in this year. So why is President Obama taking the extra-constitutional step of letting employers temporarily off the hook? The reason is not hard to understand.

The TRS ActiveCare Board of Trustees voted last week to change administrators beginning with the 2014-2015 plan year. Blue Cross, the current administrator, will be replaced by Aetna. With the state employee health plan terminating their Blue Cross contract last year and going with United HealthCare, this is a second huge hit to the Blues in less than a year.

Are Blue Cross provider contracts inferior to United HealthCare or Aetna’s? Since 90% of costs are directly related to provider reimbursement levels, and since both the State of Texas employee benefit program and the TRS ActiveCare program employ independent actuaries to review plan finances with projections, one could surmise that it must be true Blue Cross’s provider contracts pay providers more than either of their competitors.

Or was Blue Cross terminated as a sacrificial lamb due to increasing medical costs?

We suspect Blue Cross will appeal the TRS Board of Trustee’s decision. It’s not over “til” it’s over.

I just posted a video on YouTube last night from a talk I gave on Tuesday. It’s called “The $55,000 Appendectomy: What Everyone Should Know About Hospital Bills”

It’s 10 minutes long and think it’s one of my best videos. The only problem was that someone came to the talk late and accidentally tripped on the camera. The connection to my shirt microphone came loose so the audio is from the camera microphone. Still, I think it’s my best presentation to date: http://www.youtube.com/watch?v=jkAY15p2DN4

“……when a competing company made a “donation” of $15,000 to one of the current board members……..that all changed……”Contracts are just being bought and paid for,” Peña said. “This new insurance agent that happens to be the one that had all the complaints back prior to 2006, Bob Trevino, is able to walk in without going though a bid process.”

Peña described why the confidence and blatant disregard for the legal process is what most concerns him. “It’s very troubling that is so blatant,” he said. “The corruption in this case it’s done with almost no fear of consequence.”

Healthcare is becoming a retail business. The exchanges created by the ACA (1) and other forces are making consumers responsible for choosing health plans and providers. Major retailers see this, and they are deepening their health care value add, becoming healthcare providers and more. Someday soon, when you launch your Bitcoin wallet on your smart watch to pay for a prescription, the salesperson will ask, “Do you want the insurance with that?”

“Employers pick the insurance company and choose the benefits available to employees. There may be one plan or several plans. Employers can also require employees to take the employer’s health plan and to pay their share of the costs.…….” Oregon Department of Insurance

Molly Mulebriar, uninvited and working undercover, attended the 2014 HCAA Executive Forum disguised as a participant. “Mingling with the crowd was easy for Molly, especially during the late stages of Happy Hour” reported Reagan Brucinelli, Mulebriar’s senior media manager.

“The HCAA folks did an outstanding job putting together a great program this year” Mulebriar offered, nursing an early morning Bloody Mary at Starbucks while awaiting her return flight on Friday. “Met lots of interesting people including some really good contacts in the health care industry.”

When asked to sum up her impressions, Mulebriar, fishing for the elusive olive, finally opined “This group is generally optimistic about their future. Most see new and exciting opportunities, while a few are struggling to embrace change. The sessions were terrific, with excellent speakers.”

“Accountable care organizations and narrow networks are two of the options that are becoming more attractive to employers, however, many employers are looking for an even more impactful cost savings strategy. Enter reference-based pricing plans.” – www.healthgram.com

“In 90-days you can offer your clients a legally defensible Medicare Plus model that is scalable and will eliminate the threat of balance billing to plan sponsors and their employees. Call or email today to learn more about Reference Based Pricing.”

A Group Health Captive allows members to share a layer of risk with other group members. If the group runs well, money is returned to the group members that participated in the surplus. If it runs poorly, their paid in premium and potentially their collateral is used to pay claims. It’s the next step of self-funding beyond traditional stop-loss programs.

Here’s what this program offers you (the writing agent):

Same underwriting process as traditional stop-loss programs (it’s easy to get started)

Aggressive pricing – underwriting is based on Reference Based Pricing

Hospital (Facility) charges for high cost claimants will be reduced 20-50%.

Better plan performance = stickier clients, more referrals

Offers the opportunity for the consultant to share risk with his client (additional revenue potential for “you”)

Higher commission potential than fully insured (and your clients will be happy to pay it due to lower overall plan costs)

This Group Health Captive offers a great story!! It can save qualified clients a ton of money and makes you look great in their eyes. When was the last time you offered your client something truly exciting?

Call or email today to inquire about this program and obtain the RFP guidelines. Email Magellan 857.636.9755

The pervasive use of generic over brand-name medications was anticipated to be a money-saver, but recently prices are soaring, even up 6,000 percent for some common drugs that were once fairly low-cost.